Provider Demographics
NPI:1821278607
Name:WILLIAM H BORDELON, MD, PA
Entity Type:Organization
Organization Name:WILLIAM H BORDELON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-359-5874
Mailing Address - Street 1:1600 S COULTER ST
Mailing Address - Street 2:BLDG A, STE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1710
Mailing Address - Country:US
Mailing Address - Phone:806-359-5847
Mailing Address - Fax:806-359-9384
Practice Address - Street 1:1600 S COULTER ST
Practice Address - Street 2:BLDG A, STE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-359-5847
Practice Address - Fax:806-359-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174282701Medicaid
TXB21392Medicare UPIN
TX174282701Medicaid